Importance of the quotient of albumin, quotient of immunoglobulin G and Reibergram in inflammatory neurological disorders with disease-specific patterns of blood-brain barrier permeability

Abstract

Background: There are still insufficient quantitative comparisons of phase-dependent blood-brain barrier permeability among inflammatory central nervous system disorders. Aim: By using the Reibergram (2-D diagram of the quotient of albumin and quotient of immunoglobulin G), we visually compared the extent of blood-brain barrier permeability among inflammatory central nervous system disorders. Methods: Both the quotient of albumin and that of immunoglobulin G in the acute and chronic phase were calculated in non-herpetic meningitis, septic meningitis, multiple sclerosis and neuromyelitis optica, and were plotted on the Reibergram. As controls, samples from non-inflammatory patients without pleocytosis were collected. The correlation coefficient between each cerebrospinal fluid biomarker and disease severity index in each disorder was also studied. Results: In the controls, the distribution differed between males and females, suggesting a sex-dependent difference in blood-brain barrier-function, in addition to the age-related compromise. A compromised blood-brain barrier was confirmed in the acute phase of meningitis and neuromyelitis optica, but not in the acute phase of multiple sclerosis. However, blood-brain barrier permeability significantly correlated with the severity and disability in multiple sclerosis. In meningitis, a compromised blood-brain barrier correlated well with the length of hospitalization rather than cerebrospinal fluid cell count. Conclusion: Visualization of the blood-brain barrier permeability with a Reibergram indicated distinct pathophysiology in each disorder. The quotient of albumin and quotient of immunoglobulin G would be useful for estimating the pathophysiology in each disorder, and the severity of ongoing inflammation or damage in the central nervous system.